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Abstract
This paper provides a historical context
for this meeting, which aimed to examine critically the way we have
defined iron-deficiency
anemia as a public health problem. The terms and
concepts used to define the problem are reviewed first, followed by
estimates
of the global prevalence of the problem from 1985
to 2000. It is argued that recent estimates are not credible and that we
must redefine the problem in terms that are
important, measurable and addressable. This meeting was designed to take
first
steps toward that goal, namely, to identify the
causal factors (e.g., iron deficiency vs. iron-deficiency anemia vs.
severe
anemia from any cause) that link iron-deficiency
anemia to important health outcomes and to estimate the magnitude of
their
effects in public health terms.
The impetus for this meeting was the
conviction that we must define the problem of iron-deficiency anemia in
terms of its
health consequences in human populations. To do this
with clarity, we must look critically at the evidence. First, this
meeting
must be put in historical context. Where have we come
from in defining iron-deficiency anemia as a public health problem?
Where do we hope to go?
WHERE HAVE WE COME FROM? TERMS AND CONCEPTS
The initial term and concept was nutritional anemias. Although this term is not commonly used today, it lives on in the name
of the International Nutritional Anemia Consultative Group (INACG).3
Nutritional anemia was defined in a 1968 WHO technical report as “a
condition in which the hemoglobin content of the blood
is lower than normal as a result of a deficiency of
one or more essential nutrients, regardless of the cause of such
deficiency.”
To determine which nutritional
deficiencies were most responsible, WHO coordinated a series of studies
in pregnant women in
which anemia, serum folate, transferrin saturation
and serum B-12 were assessed. They concluded that “Iron deficiency was
present in 40–99% of the pregnant women studied and
was undoubtedly responsible for the major proportion of anemia” (WHO 1968).
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